Healthcare Provider Details

I. General information

NPI: 1447575741
Provider Name (Legal Business Name): BRENDA LYNN MCGUANE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NORTH PARK ST.
SENECA FALLS NY
13148
US

IV. Provider business mailing address

7549 POTTER RD
INTERLAKEN NY
14847-9665
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-9412
  • Fax: 315-568-6718
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number551811
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: